High Velocity Medicine

Moving Toward High Velocity Medicine
From The Rock:
Where is the wisdom that we have lost in knowledge?
Where is the knowledge that we have lost in information?
-- T.S. Eliot, 1934
A while back I had a great conversation with Vi Shaffer and folks from Gartner. I've known Vi forever and find her to be a smart and insightful person who knows the field of health informatics quite well. We were talking about 'nanotechnology' for some background research I was doing for projects at Partners, and we got to talking about clinical decision support and knowledge management along the way. This conversation helped me crystallize one of the major issues I see confronting US healthcare delivery, and for that matter, healthcare delivery around the world: the need for High Velocity Medicine. Try this on for size:

 Many in the field have talk for years about the DIKW pyramid, which I think started simply as the DIK pyramid. In any case, the basic idea is that we live in a world of data about nearly everything -- especially as more and more of our lives are 'quantified', and the world is painted in a digital facsimile of itself (aka the Matrix!). Data are the objective facts about our existence, or for example: the height of Mt Everest in the graphic. Data may be compiled, however, to give us insights about things, or information. For example, the average height of mountains in Nepal, or a book about Mt Everest. When internalized, information becomes knowledge, or something we know first hand. But it is the last step, transforming knowledge into practice that is the true goal -- knowledge acted upon is wisdom. And with wisdom and experience, we need to know which data to look at again to complete the cycle, and create a virtuous learning system.



Some have suggested that it may take as long as 25 years or more to covert new data into wisdom, e.g. to take a new clinical trial result and see it in routine clinical practice. In a seminal paper, Lau described in the NEJM in 1992 how long it took for thrombolytic therapy in acute MI to diffuse into routine practice -- the first clinical trial was performed in 1960, and thrombolytics in AMI became routine only in 1985. 

Given the appalling rate at which we routinely exercise our wisdom in daily life, or the practice of medicine, it is no surprise that this graphic is shaped like a pyramid -- perhaps implying less wisdom among us mortals, than knowledge, information, or data.

Yet, it is a central idea of biomedical informatics that we can improve upon this process of translation from data to wisdom, and apply it in the routine practice of medicine as wise, seasoned clinicians. We need to dramatically accelerate this translation of data to knowledge, and discern when is new knowledge 'true' and ready for general use, vs. that knowledge which is observed, and possibly even replicated, but perhaps not yet generally applicable.

To me, this suggests a new theory of evidence given the volume, speed, and diversity of sources of new data (aka 'big data') -- moving from hypothesis-driven clinical trials toward PheWAS (phenome-wide) and GWAS (genome-wide) association studies… with biologic plausibility and clear certainty assessments. But that's another topic.

With the explosion of biomedical data -- data on genotypes, phenotypes, social interactions, behavior, geospatial, populations, community, and more to come -- it is incumbent upon us to focus on the acceleration of this translation from data to wisdom, it's dissemination, and implementation in the tools of the day: electronic health records. I suggest this will lead to 'high velocity medicine': when we are agile with new data, compile it into information with routine ease, quickly understand and interpret it into new knowledge, and act upon it as wisdom with alacrity. This is the fuel for Berwick's "escape fire" - avoiding the current conflagration through the transformation and optimization of healthcare delivery, and the primary pursuit of health and wellness.

Discussion with Vi Schaffer of Gartner

Lau J, Antman EM, Jimenez-Silva J, et al. Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med 1992;327:248–54.
Berwick, D. Escape Fire: Lessons from the Future of Healthcare. 2002, The Commonwealth Fund.

"The Why" to be a Clinical Informaticist

Recently, at an informatics meeting it was suggested by a colleague that we all watch a recent TedTalk. I was moved by Simon Sinek's talk on "The Why" -- he eloquently discusses leading with 'the why', and not overly focusing on 'the how', or 'the what'. I suggest you take 8.5' to watch Sinek's video on 'The Why'. Ask yourself if are you focusing on the why, the how, or the what. All are important, but in different, sometimes not well understood, ways. So I asked myself: Why do I do what I do? Here's the answer today:

• To make it fun to practice medicine
• To help people get better
• To make the patient care experience better
• To improve the quality of care
• To lower the costs of care
• To learn every day
• To work with smart, dedicated, and caring people
• To discover something new, bright, and shiny
• To take delight in seeing a new idea come to life
• To leave the world a better place

I'd like to suggest we all think about why we do what we do, which effectively guides the how and the what.

Beatles Songs for Health Information Technology (HIT, EMR, CPOE)

I've recently discovered that the song medley performed at my opening session during HIMSS 2006 Annual Symposium may be freely shared (with attribution). This is a set of Beatles classics with words re-written to highlight the value of HIT (!), with a slightly more sedate opener and closer... that's me walking off stage left after the opening skit.

Have a listen, and have a laugh, or a smile at least.  youtu.be/uaGiQaf-EdM

Cancellation: 2012 Patient-centered eHealth Course

Folks,  Given our low registration count to date, and low corporate sponsorships to date, I have made the difficult decision to cancel our HMS CME Course for 2012. 

 

We are unlikely to garner any more corporate support at this point, and the rate of registrations to date is lower than previous course years.  Both these factors have contributed to the potential for a significant budget deficit if we proceeded to hold the course this year.

 

We look forward to conducting this course again (or a revised course on the hottest topics of the day) another year!

Best, 

Blackford

Harvard CME Course on EMR, PHR, Meaningful Use -> Health Care Transformation

2012 Patient-centered Computing and eHealth: Transforming Healthcare Quality

We are pleased to announce that the Clinical Informatics Research & Development group (CIRD) at Partners HealthCare System, and the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, are sponsoring, for a fifth year, the Harvard Medical School Continuing Medical Education course entitled: Patient-Centered Computing and eHealth:Transforming Healthcare Quality, April 30-May 2, 2012, at the Conference Center at Waltham Woods. This course is comprised of 2 1/2 days of keynote presentations, workshops, and panel discussions, which explore current topics in the meaningful and effective use of health IT for providers and patients. Our Faculty are drawn from the experts across Partners HealthCare, Harvard Medical School, and across the country – each with deep real world experience in the issues that must be considered to effectively design, implement, and use health IT to transform care. Our students are healthcare leaders, clinicians, and IT professionals, — all of whom are dedicated to the effective use of health it to transform health care quality, improve patient safety, and reduce unwarranted costs of care.

Below is some of the great feedback we received from prior courses:

"Really thought this was an extremely high value experience. The effort was obvious. I greatly appreciated the opportunity to participate."
"The workshop topics were wonderful. It would have been terrific to be able to attend them all!"
"I saw the entire course presenting the [health IT] situation with all of the associated issues that need to be accommodated and considered. It did not provide a solution - the perfect solution is not there yet - this provides the things to consider in getting there - it presented the fully reality and presented it quite well."
“Top faculty. Great organization and scheduling. Varied educational methods.”

Brief 2012 Course Description

This practical course presents the work of national experts in patient-centered computing and eHealth using a format that will enable acquisition of new knowledge and allow students to take-away skills for immediate application back home. Through plenary presentations, panel discussions and workshops, participants will have an opportunity to see the ‘big picture’, understand current best practices, and take away practical lessons learned and insights about how to effectively use health IT. Students will interact with experts about the current opportunities and challenges that arise from implementation and use of patient-centered health IT tools, including, but not limited to: best practices and guidelines for the use of eHealth applications (e.g. Electronic Health Records [EHRs], Personal Health Records [PHRs], secure messaging, web visits), the evidence base regarding health IT’s role in behavior change and chronic disease self-management (e.g. diabetes, heart failure, depression), the role of eHealth in enhancing patient safety and reducing medical error, and potential unintended consequences of use the value proposition for physicians and other stakeholders of using eHealth strategies, patients' perspectives on eHealth applications and technologies, and their viewpoint about the impact on healthcare costs, quality and satisfaction, information about working collaboratively and communicating effectively with patients to assess and differentiate the quality of healthcare information on the Internet, and publicly reported quality measures, opportunities and risks in clinical data sharing, the potential for provider and patient technologies to support improved public health reporting and community wellness, and future research and development directions in patient-centered computing and eHealth.

Keynoters for 2012 include:

David Blumenthal, MD, Harvard Medical School - e-Health for Patient Safety, Quality, and Care: Transforming U.S. Healthcare

Dr. David Blumenthal is the founding director of the Mongan Institute for Health Policy at MGH, and has returned to the Massachusetts General Hospital following two years in Washington, DC, as the National Coordinator for Health Information Technology for the Obama administration. In his role at the ONC, Dr. Blumenthal forged policies that will guide the development and dissemination of electronic health records (EHRs) for decades to come. In particular, he led the initiative that set standards for meaningful use of EHRs, which in turn determine the content and functionality of these records. Dr. Blumenthal has advised Democratic presidential candidates from Michael Dukakis to Barack Obama on health related issues, and is the author of The Heart of Power: Health and Politics in the Oval Office. In this keynote presentation, Dr. Blumenthal will review the current state of health care and eHealth, and discuss the future needs and opportunities for eHealth to help transform U.S. healthcare delivery.

Victor Strecher, PhD, MPH, University of Michigan - Personalizing and Tailoring Clinical Care to Improve Patient Health Outcomes

Evidence supports the benefits of tailoring eHealth applications. They are more salient, increase adoption and reach and have greater impact. The process of “deep tailoring” is emerging, which goes beyond tailoring based upon demographic and nominal characteristics only to include more culturally sensitive and multi-level variables. This approach to the design of personalized services has implications for practice re-design and the potential to enhance health outcomes, making it relevant to the practicing provider. Key concepts will be described and examples presented from current applications.

John D. Halamka, MD, Beth Israel Deaconess Medical Center, Harvard Medical School - Toward Meaningful Use: National Policy and Standards Review and Update

The landscape for health information technology (HIT) standards is evolving quickly in the U.S. with financial incentives, regulatory reform and legislation to support HIT adoption and meaningful use. Dr. Halamka, recognized as a national expert in this field and Chair of the US Healthcare Information Technology Standards Panel (HITSP), will review nationwide activities, policy initiatives, standards normalization and acceleration and EHR certification and tell you what you need to know as it applies to your clinical practice.

Robert Wachter, MD, University of California, San Francisco -- Digital Medicine in the Era of Health Reform

Dr. Robert Wachter will highlight the current state of the art of medical practice with respect to quality and patient safety, and the opportunity for health IT to contribute to transformation of U.S. healthcare delivery. In his books, Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes, and Understanding Patient Safety, Dr. Wachter has described the many ways in which we need to improve upon how U.S. healthcare is delivered. He is widely regarded as the founder of the Hospitalist movement, and a leading expert in patient safety and quality: he is the editor of the AHRQ Web M&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive over two million unique visits each year.

Kim Nazi, FACHE, PhDc, Veterans Health Administration -- 5th Annual Warner Slack Keynote Lecture - Project Health Design and eHealth: Designing the Future of Healthcare

Healthcare delivery systems of the future will require deep understanding of consumer/patient needs for engagement in their own health and wellness, health information management, and decision support. Patients will seek PHR systems which are personal, connected, and provide value. They must be supportive and enabling of increasing consumerism. This bold vision of PHR systems will be presented in the context of the transformation of the present health care system into a more patient-centric one. Key examples to illuminate these issues will be drawn from the Robert Wood Johnson Foundation “Project Health Design.”

David Ahern, PhD, Brigham and Women’s Hospital, Harvard Medical School -- Behavioral Health Informatics and eHealth: Aligning Decision-Support Systems to the Cognitive Models of Providers and Patients

Patients and providers often have radically different ideas about the health and disease states they are working on improving together. These differences impact communication, understanding, and healthcare outcomes. Consideration of the cognitive models of patients and providers in the design of health IT applications and personalized services is critical for successful practice re-design and the effective use and application of health IT. Theories underlying behavioral health informatics will be discussed, and practical examples presented demonstrating their impact on EMR and PHR design and use.

Blackford Middleton, MD, MPH, MSc, Brigham and Women’s Hospital, Partners Heatlhcare, Harvard Medical School -- Thinking about Clinical Decision Support: A Review of the State of the Art

Dr. Middleton will address the patient safety imperative and healthcare transformation using healthcare IT and clinical decision support. He will discuss critical features and functions of EHRs and PHRs; and discuss the current state of the art with respect to providing effective clinical decision support for providers and patients using these technologies. Notable findings from current research and examples from current applications will be presented.

e-Patient Dave deBronkart: Patients’ Perspectives on eHealth

Dave deBronkart is the leading voice on patient engagement. A cancer survivor, he has dedicated his new life to improving patient-provider communication, is a co-founder of the Society of Participatory Medicine, and speaks widely on the role of the activated patient in wellness, and disease. In his books Laugh, Sing, and Eat Like a Pig, and Facing Death with Hope, he speaks to people who are staring death in the face and are wondering, “What on earth do I do now?” He will share his story and insights and highlight the role of the patient in eHealth.

This course would note be possible without generous unrestricted educational grants from:

Intersystems
Intelligent Medical Objects
NextGen
Thanks for reading -- hope to see you there!

2012 Patient-centered Computing and eHealth: Transforming Healthcare Quality

We are pleased to announce that the Clinical Informatics Research & Development group (CIRD) at Partners HealthCare System, and the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, are sponsoring, for a fifth year, the Harvard Medical School Continuing Medical Education course entitled: Patient-Centered Computing and eHealth:Transforming Healthcare Quality, April 30-May 2, 2012, at the Conference Center at Waltham Woods. 


This course is comprised of 2 1/2 days of keynote presentations, workshops, and panel discussions, which explore current topics in the meaningful and effective use of health IT for providers and patients. Our Faculty are drawn from the experts across Partners HealthCare, Harvard Medical School, and across the country – each with deep real world experience in the issues that must be considered to effectively design, implement, and use health IT to transform care. Our students are healthcare leaders, clinicians, and IT professionals,  — all of whom are dedicated to the effective use of health it to transform health care quality, improve patient safety, and reduce unwarranted costs of care.

Below is some of the great feedback we received from prior courses:

• "Really thought this was an extremely high value experience.  The effort was obvious.  I greatly appreciated the opportunity to participate."
• "The workshop topics were wonderful.  It would have been terrific to be able to attend them all!"
• "I saw the entire course presenting the [health IT] situation with all of the associated issues that need to be accommodated and considered.  It did not provide a solution - the perfect solution is not there yet - this provides the things to consider in getting there - it presented the fully reality and presented it quite well."
• “Dr. Middleton & his team at Harvard are at the epicenter of bringing effective Continuous Quality Improvement to main stream medicine.”
• “Top faculty. Great organization and scheduling. Varied educational methods.”

Brief 2012 Course Description

This practical course presents the work of national experts in patient-centered computing and eHealth using a format that will enable acquisition of new knowledge and allow students to take-away skills for immediate application back home. Through plenary presentations, panel discussions and workshops, participants will have an opportunity to see the ‘big picture’, understand current best practices, and take away practical lessons learned and insights about how to effectively use health IT.

Students will interact with experts about the current opportunities and challenges that arise from implementation and use of patient-centered health IT tools, including, but not limited to:

• best practices and guidelines for the use of eHealth applications (e.g. Electronic Health Records [EHRs], Personal Health Records [PHRs], secure messaging, web visits),
• the evidence base regarding health IT’s role in behavior change and chronic disease self-management (e.g. diabetes, heart failure, depression),
• the role of eHealth in enhancing patient safety and reducing medical error, and potential unintended consequences of use
• the value proposition for physicians and other stakeholders of using eHealth strategies,
• patients' perspectives on eHealth applications and technologies, and their viewpoint about the impact on healthcare costs, quality and satisfaction,
• information about working collaboratively and communicating effectively with patients to assess and differentiate the quality of healthcare information on the Internet, and publicly reported quality measures,
• opportunities and risks in clinical data sharing,
• the potential for provider and patient technologies to support improved public health reporting and community wellness, and
• future research and development directions in patient-centered computing and eHealth.

Keynoters for 2012 include: 

David Blumenthal, MD, Harvard Medical School - e-Health for Patient Safety, Quality, and Care: Transforming U.S. Healthcare

Dr. David Blumenthal is the founding director of the Mongan Institute for Health Policy at MGH, and has returned to the Massachusetts General Hospital following  two years in Washington, DC, as the National Coordinator for Health Information Technology for the Obama administration. In his role at the ONC, Dr. Blumenthal forged policies that will guide the development and dissemination of electronic health records (EHRs) for decades to come. In particular, he led the initiative that set standards for meaningful use of EHRs, which in turn determine the content and functionality of these records. Dr. Blumenthal has advised Democratic presidential candidates from Michael Dukakis to Barack Obama on health related issues, and is the author of The Heart of Power: Health and Politics in the Oval Office. In this keynote presentation, Dr. Blumenthal will review the current state of health care and eHealth, and discuss the future needs and opportunities for eHealth to help transform U.S. healthcare delivery.

Victor Strecher, PhD, MPH, University of Michigan - Personalizing and Tailoring Clinical Care to Improve Patient Health Outcomes

Evidence supports the benefits of tailoring eHealth applications. They are more salient, increase adoption and reach and have greater impact. The process of “deep tailoring” is emerging, which goes beyond tailoring based upon demographic and nominal characteristics only to include more culturally sensitive and multi-level variables. This approach to the design of personalized services has implications for practice re-design and the potential to enhance health outcomes, making it relevant to the practicing provider. Key concepts will be described and examples presented from current applications.

John D. Halamka, MD, Beth Israel Deaconess Medical Center, Harvard Medical School - Toward Meaningful Use: National Policy and Standards Review and Update

The landscape for health information technology (HIT) standards is evolving quickly in the U.S. with financial incentives, regulatory reform and legislation to support HIT adoption and meaningful use. Dr. Halamka, recognized as a national expert in this field and Chair of the US Healthcare Information Technology Standards Panel (HITSP), will review nationwide activities, policy initiatives, standards normalization and acceleration and EHR certification and tell you what you need to know as it applies to your clinical practice.

Robert Wachter, MD, University of California, San Francisco -- Digital Medicine in the Era of Health Reform

Dr. Robert Wachter will highlight the current state of the art of medical practice with respect to quality and patient safety, and the opportunity for health IT to contribute to transformation of U.S. healthcare delivery. In his books, Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes, and Understanding Patient Safety, Dr. Wachter has described the many ways in which we need to improve upon how U.S. healthcare is delivered. He is widely regarded as the founder of the Hospitalist movement, and a leading expert in patient safety and quality: he is the editor of the AHRQ Web M&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive over two million unique visits each year.

Kim Nazi, FACHE, PhDc, Veterans Health Administration -- 5^th Annual Warner Slack Keynote Lecture - Project Health Design and eHealth: Designing the Future of Healthcare

Healthcare delivery systems of the future will require deep understanding of consumer/patient needs for engagement in their own health and wellness, health information management, and decision support. Patients will seek PHR systems which are personal, connected, and provide value. They must be supportive and enabling of increasing consumerism. This bold vision of PHR systems will be presented in the context of the transformation of the present health care system into a more patient-centric one. Key examples to illuminate these issues will be drawn from the Robert Wood Johnson Foundation “Project Health Design.”

David Ahern, PhD, Brigham and Women’s Hospital, Harvard Medical School -- Behavioral Health Informatics and eHealth: Aligning Decision-Support Systems to the Cognitive Models of Providers and Patients

Patients and providers often have radically different ideas about the health and disease states they are working on improving together. These differences impact communication, understanding, and healthcare outcomes. Consideration of the cognitive models of patients and providers in the design of health IT applications and personalized services is critical for successful practice re-design and the effective use and application of health IT. Theories underlying behavioral health informatics will be discussed, and practical examples presented demonstrating their impact on EMR and PHR design and use.

Blackford Middleton, MD, MPH, MSc, Brigham and Women’s Hospital, Partners Heatlhcare, Harvard Medical School -- Thinking about Clinical Decision Support: A Review of the State of the Art

Dr. Middleton will address the patient safety imperative and healthcare transformation using healthcare IT and clinical decision support. He will discuss critical features and functions of EHRs and PHRs; and discuss the current state of the art with respect to providing effective clinical decision support for providers and patients using these technologies. Notable findings from current research and examples from current applications will be presented.

Course Objectives

• Participants will gain current, state-of-the art knowledge about patient-centered computing and eHealth.
• Participants will be able to identify best practices and guidelines for the meaningful use of patient-centered health IT.
• Participants will attain a better understanding about the theoretical and practical opportunities and challenges in implementing and utilizing patient-centered eHealth applications.
• Participants will learn how to effectively use and/or implement the following eHealth technologies: EHRs, PHRs, and clinical decision support.
• Participants will attain practical understanding of the issues surrounding healthcare information exchange, and data reuse for public health and community wellness.

This course would note be possible without generous unrestricted educational grants from: 

• Nuance
• Intersystems
• Intelligent Medical Objects
• NextGen

Thanks for reading -- hope to see you there!